REOPERATION IN PATIENTS WITH PATENT ATHEROSCLEROTIC CORONARY VEIN GRAFTS - A DIFFERENT APPROACH TO A DIFFERENT DISEASE

  • 1 January 1984
    • journal article
    • research article
    • Vol. 87  (3) , 379-385
Abstract
Atherosclerotic changes are often noted in vein grafts at angiography 8-10 yr after coronary artery grafting. Reoperation in these patients is hazardous, as manipulation of the grafts may loosen atheromatous debris and cause coronary embolization and myocardial infarction. A technique is described to avoid embolization of atheromatous material during reoperation in patients with patient atherosclerotic coronary vein grafts. This technique was carried out in 6 patients and compared to the standard technique of reoperation in similar patients. The incidence of complicated perioperative myocardial infarction (0/6 vs. 5/12) and perioperative death (0 vs. 3) was lower when our new technique was used. This approach consists of minimal dissection for access to the right atrium and ascending aorta for cannulation, prompt ligation of all patent grafts at the start of cardiopulmonary bypass, cardioplegic infusion through the ascending aorta and subsequently also through newly inserted grafts using larger infusions until myocardial temperatures reach .ltoreq. 15.degree. C, and single aortic clamping for distal and proximal anastomoses.

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